When Common Ground Becomes a Healthcare Battleground

By Cassie Chambers

The addition of Paul Ryan to the Republican presidential ticket has brought the healthcare proposals of both parties to the forefront. To listen to the Sunday morning talk shows, you’d think the platforms were definitively and irreconcilably split on every health-related issue. Examining healthcare proposals from both sides, however, shows that they have more in common than you might realize.  Yet we seem to have reached a point where this common ground isn’t something to celebrate, but rather a reality to retreat from as quickly and decisively as possible.

Let’s start by rewinding a few years.


As we all know by now, Congress passed the Patient Protection and Affordable Care Act in 2010 to much Republican chagrin. One of the main features of the Act was to create health insurance exchanges, where individuals receive government subsidies to purchase private health insurance plans in a regulated market. Government’s role in overseeing this market includes requirements placed on insurers such as guaranteed issue (requiring companies to insure anyone who wants to purchase a plan) and modified community rating (limiting the amount premiums can vary between individuals based on risk alone). Although the government sought to include a public option as a way to set a standard of competition private plans must meet, intense opposition to this provision led it to be scrapped early in the process. This concession aside, Paul Ryan, Mitt Romney, and pretty much every other Republican official still blasted these changes as unconstitutional, inefficient, and an overly intrusive step for government.

Now, fast forward to campaign season 2012.

The inclusion of vice presidential candidate Paul Ryan on the Republican ticket opened up conversation about the Congressman’s controversial proposals for Medicare reform. What does this plan—much railed against by the Democrats—include? It would start by giving monetary support to seniors to purchase healthcare from private companies. These private companies would face government regulations, including guaranteed issue and the requirement that they charge everyone of the same age the same premium. Furthermore, due to concerns that fully leaving healthcare for the elderly to private markets could diminish the quality of care, a government provided plan was added to the mix of options from which seniors would be able choose. This proposal is, of course, supported by many within the party and heavily attacked from those outside it.

Sound familiar?

In fact, “Obamacare” and the Romney/Ryan Medicare proposals advocate for the same thing. The system is called “managed competition”, and Alain Enthoven began arguing for its use in healthcare several decades back. This system is based on ideas that are arguably fairly centrist: choice is good, markets produce desirable outcomes, and government must set strong rules to ensure markets work for individuals. Several countries, including the Netherlands, have adopted this type of policy; any proposals seeking a “managed competition solution” to a problem will sound somewhat similar, as this system comes with an implicit checklist—including individual mandate, guaranteed issue, and community rating—politicians must follow to ensure reform’s success.

In today’s politically polarized world, managed competition may be an increasingly popular policy solution—a middle ground between unchecked markets and increased government intervention.  Yet it seems politicians may have become blinded by the thick rhetorical webs they have spun. Instead of seeing overlaps between the parties’ platforms as a foundation to build consensus upon, Democrats and Republicans alike seek to deny any similarities to the other side.

This agreement that managed competition has the potential to solve some healthcare problems certainly doesn’t mean the parties agree on everything—indeed, Romney/Ryan want to reverse “Obamacare”, and Obama doesn’t support the Romney/Ryan voucher system for Medicare. In short, they disagree on where managed competition best fits in healthcare markets. But the important point is that there are some underlying ideas upon which they agree. Also important is the fact that any allegation of this agreement would quickly send both sides scrambling back to their respective ends of the political spectrum.

Retreating from ideas only because someone else agrees with you seems like a strange way for democracy to function.


0 thoughts to “When Common Ground Becomes a Healthcare Battleground”

  1. I think you make a good point. There certainly is room for more subtlety on this issue. However, I also would make the point that while the concepts underlying the policies or proposals in question are essentially the same, their respective effects are not.

    That is, Obamacare offers those who have no better option access to health care. The Ryan proposal turns what has been an entitlement into something less than that. I would make the analogy to defined contribution and defined benefit pension plans. Obamacare offers those with no pension a defined contribution plan. Ryancare offers thow

  2. Ryancare requires those with a defined benefit plan to switch to a defined contribution plan, which is not something that everyone would choose willingly to do.
    One can support managed competition but have principled reasons for not supporting both Obamacare and Ryancare.

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